Department of Clinical Oncology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt.
Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt.
Eur Radiol. 2024 Apr;34(4):2500-2511. doi: 10.1007/s00330-023-10150-z. Epub 2023 Oct 9.
To determine prognostic value of bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) measured on baseline dual-phase F-FDG PET/CT in a series of newly diagnosed patients with diffuse large B-cell lymphoma (DLBCL) treated homogeneously with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy.
This prospective study enrolled 135 patients with newly diagnosed DLBCL. All patients underwent dual-phase F-FDG PET/CT. The following PET parameters were calculated for both tumor and bone marrow: maximum standardized uptake value (SUVmax) at both time points (SUVmax early and SUVmax delayed), SUVmax increment (SUVinc), RI, and BLR. Patients were treated with R-CHOP regimen and response at end of treatment was assessed.
The final analysis included 98 patients with complete remission. At a median follow-up of 22 months, 57 patients showed no relapse, 74 survived, and 24 died. The 2-year relapse-free survival (RFS) values for patients with higher and lower RI-bm were 20% and 65.1%, respectively (p < 0.001), and for patients with higher and lower BLR were 30.2% and 69.6%, respectively (p < 0.001). The 2-year overall survival (OS) values for patients with higher and lower RI-bm were 60% and 76.3%, respectively (p = 0.023), and for patients with higher and lower BLR were 57.3% and 78.6%, respectively (p = 0.035). Univariate analysis revealed that RI-bm and BLR were independent significant prognostic factors for both RFS and OS (hazard ratio [HR] = 4.02, p < 0.001, and HR = 3.23, p < 0.001, respectively) and (HR = 2.83, p = 0.030 and HR = 2.38, p = 0.041, respectively).
Baseline RI-bm and BLR were strong independent prognostic factors in DLBCL patients.
Bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) could represent suitable and noninvasive positron emission tomography/computed tomography (PET/CT) parameters for predicting pretreatment risk in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) who were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy.
• Bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) are powerful prognostic variables in diffuse large B-cell lymphoma (DLBCL) patients. • High BLR and RI-bm are significantly associated with poor overall survival (OS) and relapse-free survival (RFS). • RI-bm and BLR represent suitable and noninvasive risk indicators in DLBCL patients.
在接受利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）化疗的弥漫性大 B 细胞淋巴瘤（DLBCL）新诊断患者系列中，确定基线双时相 F-FDG PET/CT 上测量的骨髓滞留指数（RI-bm）和骨髓-肝脏比（BLR）的预后价值。
本前瞻性研究纳入了 135 例新诊断为 DLBCL 的患者。所有患者均接受了双时相 F-FDG PET/CT 检查。计算了肿瘤和骨髓的以下 PET 参数：早期和延迟时的最大标准化摄取值（SUVmax）（SUVmax 早期和 SUVmax 延迟）、SUVmax 增量（SUVinc）、RI 和 BLR。患者接受 R-CHOP 方案治疗，并在治疗结束时评估治疗反应。
最终分析纳入了 98 例完全缓解的患者。在 22 个月的中位随访中，57 例患者未复发，74 例患者存活，24 例患者死亡。RI-bm 较高和较低的患者 2 年无复发生存率（RFS）分别为 20%和 65.1%（p<0.001），BLR 较高和较低的患者 2 年总生存率（OS）分别为 30.2%和 69.6%（p<0.001）。RI-bm 较高和较低的患者 2 年 OS 分别为 60%和 76.3%（p=0.023），BLR 较高和较低的患者 2 年 OS 分别为 57.3%和 78.6%（p=0.035）。单因素分析显示，RI-bm 和 BLR 是 RFS 和 OS 的独立显著预后因素（风险比 [HR]分别为 4.02，p<0.001 和 HR 分别为 3.23，p<0.001）和（HR 分别为 2.83，p=0.030 和 HR 分别为 2.38，p=0.041）。
基线 RI-bm 和 BLR 是 DLBCL 患者的独立强预后因素。
骨髓滞留指数（RI-bm）和骨髓-肝脏比（BLR）可作为合适的、非侵入性正电子发射断层扫描/计算机断层扫描（PET/CT）参数，用于预测接受利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）化疗的新诊断弥漫性大 B 细胞淋巴瘤（DLBCL）患者的治疗前风险。
RI-bm 和 BLR 是弥漫性大 B 细胞淋巴瘤（DLBCL）患者的强大预后变量。
高 BLR 和 RI-bm 与总生存（OS）和无复发生存（RFS）不良显著相关。
RI-bm 和 BLR 是 DLBCL 患者合适的、非侵入性风险指标。
